De subitaneis mortibus. XXIII. Rheumatoid arthritis and ankylosing spondylitis.

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Abstract
The conduction system of the heart was carefully examined at necropsy in 2 cases of rheumatoid arthritis and 1 of ankylosing spondylitis. All 3 patients had cardiac electrical instability and 2 of the 3 died suddenly. The electrophysiological abnormalities of the 3 patients included paroxysmal atrial fibrillation in the 1st case, sustained atrial fibrillation with complete heart block and escape atrioventricular (A-V) junctional rhythm in the 2nd case, and a progressively increasing heart block eventually became complete in the 3rd case. The sinus node exhibited extensive focal degeneration with an without associated inflammation in 3 hearts, but the sinus node artery was not remarkably abnormal in any of these. All 3 hearts had important focal degenerative disease in the A-V node and His bundle, and in each there was marked narrowing of the local nutrient arteries, amounting to virtual occlusion in 2 hearts. The probable relationship of these postmortem histological findings to the ECG disturbances in each patient is discussed. Abnormalities in the cardiac conduction system of the hearts of these 3 patients are compared to ones previously reported for disseminated lupus erythematosus, polyarteritis nodosa and scleroderma heart disease.